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All sourcesNASA NTRSDOE OSTI
DOE OSTI2014

SU-E-T-542: Comparison of Stereotactic Radiosurgery (SRS) of Brain Lesions Using Gamma Knife, VMAT, IMRT, and Conformal Arcs

Purpose: To compare dose distributions in stereotactic radiation surgery of brain lesions using gamma Knife, VMAT, conformal arcs, and IMRT in order to provide an optimal treatment. Methods: Dose distributions from single shot of 4C model of Gamma Knife at the helmet collimation sizes of 4, 8, 14, and 18 mm in diameter were compared with full arcs with the square shapes of 4×4 (or 5×5), 8×8 (or 10×10), and spherical shapes of 16 or 20 mm in diameter using EDR3 films in the same gamma knife QA phantom. Plans for ten SRS cases with single and multiple lesions were created in gamma knife plans and Pinnacle plans. The external beam plans had enlarged field size by 2-mm and used single conformal full circle arc for solitary lesion and none coplanar arcs/beams for multiple lesions. Coverage, conformity index, dose to critical organs, and integral dose to the brain and nearby critical structures were compared on all plans. Structures and dose matrices were registered in a Velocity deformable image registration system. Results: Single full circle arc from Elekta beam-modulate MLC (4-mm leaf thickness) and agility MLC (5-mm leaf thickness) have larger penumbra and less flatness than that of Gamma Knife single shot. None-coplanar arcs or beams were required to achieve similar dose distribution. In general, Gamma Knife plans provided significant less integral dose than that of linac-based plans. Benefits of IMRT and VMAT versus gamma Knife and conformal arcs were not significant. Conclusion: Our dose measurement and treatment planning evaluation clearly demonstrated dose distribution differences amount current popular SRS modalities for small solitary and multiple brain lesions. The trend of using MLC shape beams or arcs to replace conventional cones should be revisited in order to keep lower integral dose if the late correlates with some radiation-induced side effects. Pilot grant from Elekta LLC.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2012

A procedure to determine the planar integral spot dose values of proton pencil beam spots

Purpose: Planar integral spot dose (PISD) of proton pencil beam spots (PPBSs) is a required input parameter for beam modeling in some treatment planning systems used in proton therapy clinics. The measurement of PISD by using commercially available large area ionization chambers, like the PTW Bragg peak chamber (BPC), can have large uncertainties due to the size limitation of these chambers. This paper reports the results of our study of a novel method to determine PISD values from the measured lateral dose profiles and peak dose of the PPBS. Methods: The PISDs of 72.5, 89.6, 146.9, 181.1, and 221.8 MeV energy PPBSs were determined by area integration of their planar dose distributions at different depths in water. The lateral relative dose profiles of the PPBSs at selected depths were measured by using small volume ion chambers and were investigated for their angular anisotropies using Kodak XV films. The peak spot dose along the beam's central axis (D{sub 0}) was determined by placing a small volume ion chamber at the center of a broad field created by the superposition of spots at different locations. This method allows eliminating positioning uncertainties and the detector size effect that could occur when measuring it in single PPBS. The PISD was then calculated by integrating the measured lateral relative dose profiles for two different upper limits of integration and then multiplying it with corresponding D{sub 0}. The first limit of integration was set to radius of the BPC, namely 4.08 cm, giving PISD{sub RBPC}. The second limit was set to a value of the radial distance where the profile dose falls below 0.1% of the peak giving the PISD{sub full}. The calculated values of PISD{sub RBPC} obtained from area integration method were compared with the BPC measured values. Long tail dose correction factors (LTDCFs) were determined from the ratio of PISD{sub full}/PISD{sub RBPC} at different depths for PPBSs of different energies. Results: The spot profiles were found to have angular anisotropy. This anisotropy in PPBS dose distribution could be accounted in a reasonable approximate manner by taking the average of PISD values obtained using the in-line and cross-line profiles. The PISD{sub RBPC} values fall within 3.5% of those measured by BPC. Due to inherent dosimetry challenges associated with PPBS dosimetry, which can lead to large experimental uncertainties, such an agreement is considered to be satisfactory for validation purposes. The PISD{sub full} values show differences ranging from 1 to 11% from BPC measured values, which are mainly due to the size limitation of the BPC to account for the dose in the long tail regions of the spots extending beyond its 4.08 cm radius. The dose in long tail regions occur both for high energy beams such as 221.8 MeV PPBS due to the contributions of nuclear interactions products in the medium, and for low energy PPBS because of their larger spot sizes. The calculated LTDCF values agree within 1% with those determined by the Monte Carlo (MC) simulations. Conclusions: The area integration method to compute the PISD from PPBS lateral dose profiles is found to be useful both to determine the correction factors for the values measured by the BPC and to validate the results from MC simulations.

43 PARTICLE ACCELERATORS↗
DOE OSTI2014

SU-E-T-151: Enhanced Radiation Attenuation with Multi-Layer Foils

Purpose: To evaluate the effect of increasing the number of thin high Z foils on the dose enhancement and the overall radiation attenuation with a 24MV photon beam. Methods: DOSXYZnrc was used to perform Monte Carlo simulations of multi-layer lead foil configurations. The foil size was 7cm x 7cm. and the foil thickness was adjusted to give a combined thickness of 1mm. The number of foils used was 4, 6, 8, and 10. The separation between foils was also varied from 3 to 9 mm. The Mohan 24MV energy spectrum was used as a photon source. The field size was 5cm x 5cm and SSD was 100 cm. The phantom size was 16cm × 16cm × 28cm. The number of histories ranged from 1 to 2 billion. The percentage difference of the dose between the medium with foils and the homogeneous water was computed along the beam axis. The minimum dose enhancement and the change of integrated dose between the foils were determined. Results: Increasing the number of foils resulted in a decrease in the minimum dose enhancement. The highest dose region occurred in the last section for the 4 and 6 foil cases, whereas the 8 and 10 foil configurations showed the maximum dose region towards the center of the foil group. Increasing the number of foils increased the total integrated dose between foils. For example, the total integrated dose increase between the first and the last foils with a 3mm foil separation were 34.2, 43.4, 57.4, and 64.7% for 4, 6, 8 and 10 foils, respectively. Conclusion: This work showed the degree of dose enhancement around multiple thin lead foils. The results suggest that the total attenuation of photon beam can be increased by increasing the number of foils with a fixed total foil thickness.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2012

Dosimetric Comparison of Three-Dimensional Conformal Proton Radiotherapy, Intensity-Modulated Proton Therapy, and Intensity-Modulated Radiotherapy for Treatment of Pediatric Craniopharyngiomas

Purpose: Cranial irradiation in pediatric patients is associated with serious long-term adverse effects. We sought to determine whether both three-dimensional conformal proton radiotherapy (3D-PRT) and intensity-modulated proton therapy (IMPT) compared with intensity-modulated radiotherapy (IMRT) decrease integral dose to brain areas known to harbor neuronal stem cells, major blood vessels, and other normal brain structures for pediatric patients with craniopharyngiomas. Methods and Materials: IMRT, forward planned, passive scattering proton, and IMPT plans were generated and optimized for 10 pediatric patients. The dose was 50.4 Gy (or cobalt Gy equivalent) delivered in 28 fractions with the requirement for planning target volume (PTV) coverage of 95% or better. Integral dose data were calculated from differential dose-volume histograms. Results: The PTV target coverage was adequate for all modalities. IMRT and IMPT yielded the most conformal plans in comparison to 3D-PRT. Compared with IMRT, 3D-PRT and IMPT plans had a relative reduction of integral dose to the hippocampus (3D-PRT, 20.4; IMPT, 51.3%{sup Asterisk-Operator }), dentate gyrus (27.3, 75.0%{sup Asterisk-Operator }), and subventricular zone (4.5, 57.8%{sup Asterisk-Operator }). Vascular organs at risk also had reduced integral dose with the use of proton therapy (anterior cerebral arteries, 33.3{sup Asterisk-Operator }, 100.0%{sup Asterisk-Operator }; middle cerebral arteries, 25.9%{sup Asterisk-Operator }, 100%{sup Asterisk-Operator }; anterior communicating arteries, 30.8{sup Asterisk-Operator }, 41.7%{sup Asterisk-Operator }; and carotid arteries, 51.5{sup Asterisk-Operator }, 77.6{sup Asterisk-Operator }). Relative reduction of integral dose to the infratentorial brain (190.7{sup Asterisk-Operator }, 109.7%{sup Asterisk-Operator }), supratentorial brain without PTV (9.6, 26.8%{sup Asterisk-Operator }), brainstem (45.6, 22.4%{sup Asterisk-Operator }), and whole brain without PTV (19.4{sup Asterisk-Operator }, 34.4%{sup Asterisk-Operator }) were recorded with the use of proton therapy. ({sup Asterisk-Operator }Differences were significant based on Friedman's test with Bonferroni-Dunn correction, {alpha} = 0.05) Conclusions: The current study found that proton therapy was able to avoid excess integral radiation dose to a variety of normal structures at all dose levels while maintaining equal target coverage. Future studies will examine the clinical benefits of these dosimetric advantages.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2014

SU-E-T-221: Investigation of Lower Energy (< 6 MV) Photon Beams for Cancer Radiotherapy

Purpose: To study the potential applications of the lower energy (< 6MV) photon beams in the radiotherapeutic management of pediatric cancer and lung cancer patients. Methods: Photon beams of 2, 3, 4, 5 and 6MV were first simulated with EGS4/BEAM and then used for Monte-Carlo dose calculations. For four pediatric patients with abdominal and brain lesions, six 3D-conformal radiotherapy (3DCRT) plans were generated using single photon energy (2 to 6MV) or mixed energies (3 and 6MV). Furthermore, a virtual machine of 3 and 6MV was commissioned in a treatment planning system (TPS) based on Monte-Carlo simulated data. Three IMRT plans of a lung cancer patient were generated on this virtual machine. All plans were normalized to D95% of target dose for 6MV plan and then compared in terms of integral dose and OAR sparing. Results: For the four pediatric patients, the integral dose for the 2, 3, 4 and 5MV plans increased by 9%, 5%, 3.5%, 1.7%, respectively as compared to 6MV. Almost all OARs in the 2MV plan received more than 10% more doses than 6MV. Mixed energy 3DCRT plans were of the same quality as 6MV plans. For the lung IMRT plans, both the 3MV plan and the mixed beam plan showed better OAR sparing in comparison to 6MV plan. Specifically, the maximum and mean doses to the spinal cord in the mixed energy plan were lower by 21% and 16%, respectively. Conclusion: Single lower energy photon beam was found to be inferior to 6MV in the radiotherapy of pediatric patients and lung cancer patients when the integral doses and the doses to the OARs were considered. However, mixed energy plans combining low with high energy beams showed significant OAR sparing while maintaining the same PTV coverage. Investigation with more patient data is ongoing for further confirmation.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2012

Development and Evaluation of Multiple Isocentric Volumetric Modulated Arc Therapy Technique for Craniospinal Axis Radiotherapy Planning

Purpose: To develop and compare a volumetric modulated arc therapy (VMAT) technique with conventional radiotherapy for craniospinal irradiation with respect to improved dose conformity and homogeneity in the planning target volume (PTV) and to reduced dose to organs at risk (OAR). Methods and Materials: Conventional craniospinal axis radiotherapy plans of 5 patients were acquired. The median (range) length of the PTV was 58.9 (48.1-83.7) cm. The 6-MV VMAT plans were inversely planned with one isocenter near the base of the brain and the minimum number of isocenters required for the specified lengths of spine. The plans were optimized with high weighting for PTV coverage and low weighting for OAR sparing. Conformity and heterogeneity indices, dose-volume histograms, mean doses, and non-PTV integral doses from the two plans (prescription dose 23.4 Gy in 13 fractions) were compared. Results: The median (range) conformity index of VMAT was 1.22 (1.09-1.45), compared with 1.69 (1.44-2.67) for conventional plans (p = 0.04). The median (range) heterogeneity index was also lower for VMAT compared with conventional plans: 1.04 (1.03-1.07) vs. 1.12 (1.09-1.19), respectively (p = 0.04). A significant reduction of mean and maximum doses was observed in the heart, thyroid, esophagus, optic nerves, and eyes with VMAT when compared with conventional plans. A decrease in body V{sub 10Gy} was observed, but for 4 of 5 patients non-PTV integral dose was increased with VMAT when compared with the conventional plans. Conclusions: A VMAT technique to treat the craniospinal axis significantly reduces OAR dose, potentially leading to lower late organ toxicity. However, this is achieved at the expense of increased low-dose volumes, which is inherent to the technique, carrying a potentially increased risk of secondary malignancies.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-331: Dosimetric Impact of Multileaf Collimator Leaf Width On Stereotactic Radiosurgery (SRS) RapidArc Treatment Plans for Single and Multiple Brain Metastases

Purpose: To determine the effects of multileaf collimator (MLC) leaf width on normal-brain-tissue doses and dose conformity of SRS RapidArc treatment plans for brain tumors. Methods: Ten patients with 24 intracranial tumors (seven with 1–2 and three with 4–6 lesions) were planned using RapidArc for both Varian Millennium 120 MLC (5 mm leaf width) and high definition (HD) MLC (2.5 mm leaf width). Between 2 and 8 arcs were used with two full coplanar arcs and the rest non-coplanar half arcs. 6 MV beams were used and plans were optimized with a high priority to the Normal Tissue Objective (to achieve dose conformity and sharp dose fall-off) and normal brain tissue. Calculation was done using AAA on a 1 mm grid size. The prescription dose ranged from 14–22 Gy. Plans were normalized such that 99% of the target received the prescription dose. Identical beam geometries, optimizations, calculations, and normalizations were used for both plans. Paddick Conformity Index (PCI), V4, V8 and V12 Gy for normal brain tissue and Integral Dose were used for analysis. Results: In all cases, HD MLC plans performed better in sparing normal brain tissue, achieving a higher PCI with a lower Integral Dose. The average PCI for all 24 targets was 0.75±0.23 and 0.70±0.23 (p ≤0.0015) for HD MLC and Millennium MLC plans, respectively. The average ratio of normal brain doses for Millennium MLC to HD MLC plans was 1.30±0.16, 1.27±0.15, and 1.31±0.18 for the V4, V8, and V12, respectively. The differences in normal brain dose for all criteria were statistically significant with p-value < 0.02. On average Millennium MLC plans had a 16% higher integral dose than HD MLC plans. Conclusion: Significantly better dose conformity with reduced volume of normal brain tissue and integral dose was achieved with HD MLC plans compared to Millennium MLC plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-448: Use of Mixed Photon Energy Beam in Volumetric Modulated Arc Therapy (VMAT) Treatment Plan for Prostate Cancer

Purpose: To study the impact of different photon beam combination during VMAT planning and treatment delivery. Methods: Five prostate patients with no nodal involvement were chosen for the study and only prostate was considered as target (7920cGy/44fractions). In each case, three different VMAT plans were generated with two arcs (200°–160°&160°–200°). First plan used only 6MV in both arcs (6X-6X) and second utilized 6MV&15MV (6X-15X), whereas third one used 15MV&15MV (15X-15X). For consistency, all the plans were generated by the same planner using Monaco− treatment planning system (V5.1) for Elekta Synergy− linear accelerator with 1cm leaf-width. For plan comparison, target mean dose, conformity index (CI)=Planning target volume (PTV) covered by 95% of prescription dose/PTV were analyzed. Mean doses of bladder, rectum, left femur and right femur were analyzed. Integral dose (liter-Gray) to normal tissue (patient volume minus PTV), total monitor unit (MU) required to deliver a plan and gamma pass rate for each plan was analyzed. Results: The CI for PTV was 0.9937±0.0037, 0.9917±0.0033, and 0.9897±0.0048 for 6X-6X, 6X-15X and 15X-15X, respectively. Mean dose to target slightly increases with the decrease of energy. Mean doses to bladder were 3546.23±692.13cGy, 3487.43±715.53cGy and 3504.40±683.1cGy for 6X-6X, 6X-15X and 15X-15X, respectively. Mean doses to rectum were 4294.60±309.5cGy, 4277.07±279.93cGy and 4290.77±379.07cGy. Mean doses to left femur were 2737.13±545.93cGy, 2668.67±407.12cGy and 2416.77±300.73cGy and mean doses to the right femur were 2682.70±460.81cGy, 2722.58±541.92cGy and 2598.57±481.83cGy. Higher Integral doses to normal tissue observed for 6X-6X (163.06±24.6 Litre-Gray) followed by 6X-15X (154.35±24.74 Litre-Gray) and 15X-15X (145.84±26.03 Litre-Gray). Average MU required to deliver one fraction was 680.75±72.09, 634.81±95.07 and 605.06±114.65. Gamma pass rates were 99.83±0.21, 99.53±0.27 and 99.2±0.20. Conclusion: 6X-15X VMAT plan offer dosimetric advantage compared to 6X-6X in terms of lesser MU and integral dose without significant compromise in plan quality, where as in 15X-15X, neutron contamination risk is relatively higher.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Dosimetric effect on pediatric conformal treatment plans using dynamic jaw with Tomotherapy HDA

It is important to minimize the radiation dose delivered to healthy tissues in pediatric cancer treatment because of the risk of secondary malignancies. Tomotherapy HDA provides a dynamic jaw (DJ) delivery mode that creates a sharper penumbra at the craniocaudal ends of a target in addition to a fixed jaw (FJ) delivery mode. The purpose of this study was to evaluate its dosimetric effect on the pediatric cancer cases. We included 6 pediatric cases in this study. The dose profiles and plan statistics—target dose conformity, uniformity, organ-at-risk (OAR) mean dose, beam-on time, and integral dose—were compared for each case. Consequently, the target dose coverage and uniformity were similar for different jaw settings. The OAR dose sparing depended on its relative location to the target and disease sites. For example, in the head and neck cancer cases, the brain stem dose using DJ 2.5 was reduced by more than two-fold (2.4 Gy vs. 6.3 Gy) than that obtained with FJ 2.5. The integral dose with DJ 2.5 decreased by more than 9% compared with that with FJ 2.5. Thus, using dynamic jaw in pediatric cases could be critical to reduce a probability of a secondary malignancy.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-P-37: Helical Tomotherapy to LINAC Plan Conversion Utilizing RayStation Fallback Planning

Purpose: RayStation Fallback (RSF) plan was developed to switch patient’s treatment from Helical Tomotherapy (HT) to Varian TrueBeam. Helical Tomotherapy plans were compared with the corresponding RSF plans by looking at the following dosimetric parameters: PTV coverage (Dmean and D95), Paddick conformity index (CI), uniformity index (UI=(D98-D2)/Drx) and organ-at-risk (OAR) doses. Methods: Five patients with five tumor sites including larynx, head and neck, esophagus, lung, and prostate previously treated with HT were re-planned using RSF treatment planning station(TPS) to best match the HT treatment plans. IMRT technique with nine fields 6 MV X-ray beams and a static multi-leaf collimator (MLC) were used for RSF plans without any additional attempt to further optimize the RSF plans. Results: A physician evaluated and confirmed the clinical acceptability of the RSF plans. Both HT and RSF plans gave comparable PTV coverage with a maximum percentage difference for D95 of 0.7%. HT plans had a better CIs ranging from 2%–15% higher conformity compared to RSF plans. HT plans also had better UIs for all tumor sites except the esophagus. The UIs were 1.6% to 8.9% lower for HT plans compared to RSF plans. Both HT and RSF plans gave comparable and acceptable OAR doses. However, the integral dose was 1%–15% higher for HT plans compared to RSF plans. Conclusion: RSF plans were simple and fast to generate. In the study cases of 5 various tumor sites, RSF efficiently created clinically acceptable plans without further optimization. However, further optimization for any IMRT plan can be done if clinically warranted. The absolute differences in CI and UI were small between RSF and HT plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-329: Characteristic Study of a Rado-Photoluminescenct Glass Dosimeter with Accumulated Dose

Purpose: This study investigated the effect of accumulated dose on radiophotoluminescent glass dosimeter in megavoltage photon. Methods: 45 commercially-available radio-photoluminescence glass dosimeters (RPLGD; GD-302M, Asahi Techno Glass Co., Shizuoka, JAPAN) were irradiated to 10 × 10 cm{sup 2} open-field with 6, 10 and 15 MV photon beams at 100 cm of source to surface distance and dose maximum depths. Each energy has consists of five groups which is consists of three detectors. A group #1 and #2 was irradiated about 1 Gy to 100 Gy, and estimated the integral dose response with and without annealing procedure. A group #3 was read the dose after irradiated 10 Gy of dose by 10 times repeatedly to estimate the fading effect of RPLGD. A group #4 and #5 was produced same ways with different irradiation dose such as 50 Gy for group #4 and 100 Gy for group #5. Results: From the results of group #1 and #2, an annealed detector shows linear response to integral dose but other detectors without the annealing process, has supra linearity for integral dose especially close to 100 Gy dose. For group #3, #4 and #5, the dose response of repeated irradiation, the dose response was decreased about 15%, 12% and 7% for 6 MV, 10 MV and 15MV. Conclusion: It was found that RPLGD response to accumulated dose was supra linear and this respond was altered with amount of accumulated dose to the RPLGD. In addition, the fading effect need to be concern with RPLGD.

36 MATERIALS SCIENCE↗
DOE OSTI2014

SU-F-BRF-13: Investigating the Feasibility of Accurate Dose Measurement in a Deforming Radiochromic Dosimeter

Purpose: Presage-Def, a deformable radiochromic 3D dosimeter, has been previously shown to have potential for validating deformable image registration algorithms. This work extends this effort to investigate the feasibility of using Presage-Def to validate dose-accumulation algorithms in deforming structures. Methods: Two cylindrical Presage-Def dosimeters (8cm diameter, 4.5cm length) were irradiated in a water-bath with a simple 4-field box treatment. Isocentric dose was 20Gy. One dosimeter served as control (no deformation) while the other was laterally compressed during irradiation by 21%. Both dosimeters were imaged before and after irradiation with a fast (∼10 minutes for 1mm isotropic resolution), broad beam, high resolution optical-CT scanner. Measured dose distributions were compared to corresponding distributions calculated by a commissioned Eclipse planning system. Accuracy in the control was evaluated with 3D gamma (3%/3mm). The dose distribution calculated for the compressed dosimeter in the irradiation geometry cannot be directly compared via profiles or 3D gamma to the measured distribution, which deforms with release from compression. Thus, accuracy under deformation was determined by comparing integral dose within the high dose region of the deformed dosimeter distribution versus calculated dose. Dose profiles were used to study temporal stability of measured dose distributions. Results: Good dose agreement was demonstrated in the control with a 3D gamma passing rate of 96.6%. For the dosimeter irradiated under compression, the measured integral dose in the high dose region (518.0Gy*cm3) was within 6% of the Eclipse-calculated integral dose (549.4Gy*cm3). Elevated signal was noted on the dosimeter edge in the direction of compression. Change in dosimeter signal over 1.5 hours was ≤2.7%, and the relative dose distribution remained stable over this period of time. Conclusion: Presage-Def is promising as a 3D dosimeter capable of accurately measuring dose in a deforming structure, and warrants further study to quantify comprehensive accuracy at different levels of deformation. This work was supported by NIH R01CA100835. John Adamovics is the president of Heuris Inc., which commercializes PRESAGE.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
DOE OSTI2015

SU-D-BRB-04: Plan Quality Comparison of Intracranial Stereotactic Radiosurgery (SRS) for Gamma Knife and VMAT Treatments

Purpose: To compare treatment plan quality of intracranial stereotactic radiosurgery (SRS) for VMAT (RapidArc) and Gamma Knife (GK) systems. Methods: Ten patients with 24 tumors (seven with 1–2 and three with 4–6 lesions), previously treated with GK 4C (prescription doses ranging from 14–23 Gy) were re-planned for RapidArc. Identical contour sets were kept on MRI images for both plans with tissues assigned a CT number of zero. RapidArc plans were performed using 6 MV flattening-filter-free (FFF) beams with dose rate of 1400 MU/minute using two to eight arcs with the following combinations: 2 full coplanar arcs and the rest non-coplanar half arcs. Beam selection was based on target depth. Areas that penetrated more than 10 cm of tissue were avoided by creating smaller arcs or using avoidance sectors in optimization. Plans were optimized with jaw tracking and a high weighting to the normal-brain-tissue and Normal-Tissue-Objective without compromising PTV coverage. Plans were calculated on a 1 mm grid size using AAA algorithm and then normalized so that 99% of each target volume received the prescription dose. Plan quality was assessed by target coverage using Paddick Conformity Index (PCI), sparing of normal-brain-tissue through analysis of V4, V8, and V12 Gy, and integral dose. Results: In all cases critical structure dose criteria were met. RapidArc had a higher PCI than GK plans for 23 out of 24 lesions. The average PCI was 0.76±0.21 for RapidArc and 0.46±0.20 for GK plans (p≤0.001), respectively. Integral dose and normal-brain-tissue doses for all criteria were lower for RapidArc in nearly all patients. The average ratio of GK to RapidArc plans was 1.28±0.27 (p=0.018), 1.31±0.25 (p=0.017), 1.81±0.43 (p=0.005), and 1.50±0.61 (p=0.006) for V4, V8, and V12 Gy, and integral dose, respectively. Conclusion: VMAT was capable of producing higher quality treatment plans than GK when using optimal beam geometries and proper optimization techniques.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

Feasibility of RACT for 3D dose measurement and range verification in a water phantom

Purpose: The objective of this study is to establish the feasibility of using radiation-induced acoustics to measure the range and Bragg peak dose from a pulsed proton beam. Simulation studies implementing a prototype scanner design based on computed tomographic methods were performed to investigate the sensitivity to proton range and integral dose. Methods: Derived from thermodynamic wave equation, the pressure signals generated from the dose deposited from a pulsed proton beam with a 1 cm lateral beam width and a range of 16, 20, and 27 cm in water using Monte Carlo methods were simulated. The resulting dosimetric images were reconstructed implementing a 3D filtered backprojection algorithm and the pressure signals acquired from a 71-transducer array with a cylindrical geometry (30 × 40 cm) rotated over 2π about its central axis. Dependencies on the detector bandwidth and proton beam pulse width were performed, after which, different noise levels were added to the detector signals (using 1 μs pulse width and a 0.5 MHz cutoff frequency/hydrophone) to investigate the statistical and systematic errors in the proton range (at 20 cm) and Bragg peak dose (of 1 cGy). Results: The reconstructed radioacoustic computed tomographic image intensity was shown to be linearly correlated to the dose within the Bragg peak. And, based on noise dependent studies, a detector sensitivity of 38 mPa was necessary to determine the proton range to within 1.0 mm (full-width at half-maximum) (systematic error < 150 μm) for a 1 cGy Bragg peak dose, where the integral dose within the Bragg peak was measured to within 2%. For existing hydrophone detector sensitivities, a Bragg peak dose of 1.6 cGy is possible. Conclusions: This study demonstrates that computed tomographic scanner based on ionizing radiation-induced acoustics can be used to verify dose distribution and proton range with centi-Gray sensitivity. Realizing this technology into the clinic has the potential to significantly impact beam commissioning, treatment verification during particle beam therapy and image guided techniques.

07 ISOTOPE AND RADIATION SOURCES↗
DOE OSTI2016

SU-F-T-507: Modeling Cerenkov Emissions From Medical Linear Accelerators: A Monte Carlo Study

Purpose: Cerenkov emissions are a natural byproduct of MV radiotherapy but are typically ignored as inconsequential. However, Cerenkov photons may be useful for activation of drugs such as psoralen. Here, we investigate Cerenkov radiation from common radiotherapy beams using Monte Carlo simulations. Methods: GAMOS, a GEANT4-based framework for Monte Carlo simulations, was used to model 6 and 18MV photon beams from a Varian medical linac. Simulations were run to track Cerenkov production from these beams when irradiating a 50cm radius sphere of water. Electron contamination was neglected. 2 million primary photon histories were run for each energy, and values scored included integral dose and total track length of Cerenkov photons between 100 and 400 nm wavelength. By lowering process energy thresholds, simulations included low energy Bremsstrahlung photons to ensure comprehensive evaluation of UV production in the medium. Results: For the same number of primary photons, UV Cerenkov production for 18MV was greater than 6MV by a factor of 3.72 as determined by total track length. The total integral dose was a factor of 2.31 greater for the 18MV beam. Bremsstrahlung photons were a negligibly small component of photons in the wavelength range of interest, comprising 0.02% of such photons. Conclusion: Cerenkov emissions in water are 1.6x greater for 18MV than 6MV for the same integral dose. Future work will expand the analysis to include optical properties of tissues, and to investigate strategies to maximize Cerenkov emission per unit dose for MV radiotherapy.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2013

A Dosimetric Comparison of Tomotherapy and Volumetric Modulated Arc Therapy in the Treatment of High-Risk Prostate Cancer With Pelvic Nodal Radiation Therapy

Purpose: To compare the dosimetric results of volumetric modulated arc therapy (VMAT) and helical tomotherapy (HT) in the treatment of high-risk prostate cancer with pelvic nodal radiation therapy. Methods and Materials: Plans were generated for 10 consecutive patients treated for high-risk prostate cancer with prophylactic whole pelvic radiation therapy (WPRT) using VMAT and HT. After WPRT, a sequential boost was delivered to the prostate. Plan quality was assessed according to the criteria of the International Commission on Radiation Units and Measurements 83 report: the near-minimal (D98%), near-maximal (D2%), and median (D50%) doses; the homogeneity index (HI); and the Dice similarity coefficient (DSC). Beam-on time, integral dose, and several organs at risk (OAR) dosimetric indexes were also compared. Results: For WPRT, HT was able to provide a higher D98% than VMAT (44.3 {+-} 0.3 Gy and 43.9 {+-} 0.5 Gy, respectively; P=.032) and a lower D2% than VMAT (47.3 {+-} 0.3 Gy and 49.1 {+-} 0.7 Gy, respectively; P=.005), leading to a better HI. The DSC was better for WPRT with HT (0.89 {+-} 0.009) than with VMAT (0.80 {+-} 0.02; P=.002). The dosimetric indexes for the prostate boost did not differ significantly. VMAT provided better rectum wall sparing at higher doses (V70, V75, D2%). Conversely, HT provided better bladder wall sparing (V50, V60, V70), except at lower doses (V20). The beam-on times for WPRT and prostate boost were shorter with VMAT than with HT (3.1 {+-} 0.1 vs 7.4 {+-} 0.6 min, respectively; P=.002, and 1.5 {+-} 0.05 vs 3.7 {+-} 0.3 min, respectively; P=.002). The integral dose was slightly lower for VMAT. Conclusion: VMAT and HT provided very similar and highly conformal plans that complied well with OAR dose-volume constraints. Although some dosimetric differences were statistically significant, they remained small. HT provided a more homogeneous dose distribution, whereas VMAT enabled a shorter delivery time.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2015

SU-E-T-783: Using Matrixx to Determine Transit Dose Contribution Over Clinically Useful Limits of HDR Source Activity

Purpose: Most HDR brachytherapy treatment planning systems (TPS) use TG-43 formalism to calculate dose without including transit dose corrections. Historically, measurement of this contribution has required sophisticated apparatus unavailable in most hospitals. We use Matrixx to investigate several scenarios where transit dose contribution may effect a clinical treatment. Methods: Treatment plans were generated using Oncentra Brachy TPS (Version 4.3.0.410, Nucletron ) on a CT scan of a 24-catheter Freiburg applicator (Nucletron ) laid flat on the MatriXX (IBA) detector. This detector is an array of 1020 parallel plate ion chambers. All 24 catheters were digitized and dwells within a central square region of 5×5cm of the applicator were activated. Each of the active catheters had 6 dwells in increments of 1.0cm. The plans were normalized to 10mm. This places the 100% isodose line at the correct effective point of measurement, which lies half-way between the parallel plates of the ion chambers. It is also within the clinically relevant treatment depth for superficial applications. A total of 6 plans were delivered for 3 prescription doses, 1Gy, 2Gy and 4Gy using source activities of 2.9Ci and 11.2Ci. The MatriXX array was operated to capture dosimetric snaps every 500ms and yielded an integral dose at the end of treatment. Results: A comparison of integral dose from 2 different source activities shows that the transit dose contribution is larger when the source activity is higher. It is also observed that the relative transit dose contribution decreases as prescription dose increases. This is quantified by the Gamma analysis. Conclusion: We have demonstrated that the Matrixx detector can be used to evaluate the contribution for a HDR source during transit from the HDR afterloader to a dwell location, and between adjacent dwell locations.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2014

SU-E-T-234: Modulated Photon Radiotherapy (XMRT):The Impact of Incorporating Energy Modulation Into Intensity Modulated Radiotherapy (IMRT) Optimization

Purpose: To develop a new radiotherapy plan optimization technique that, for a given organ geometry, will find the optimal photon beam energies and fluences to produce a desirable dose distribution. This new modulated (both in energy and fluence) photon radiotherapy (XMRT) was compared with intensity modulated radiotherapy (IMRT) for a simple organ geometry. Methods: The XMRT optimization was formulated using a linear programming approach where the objective function is the mean dose to the healthy organs and dose-point constraints were assigned to each organ of interest. The organ geometry consisted of a target, two organs at risk (OARs), and normal tissue. A seven-equispaced-coplanar beam arrangement was used. For conventional IMRT, only 6 MV beams were available, while XMRT was optimized using 6 and 18 MV beams. A prescribed dose (PD) of 72 GY was assigned to the target, with upper and lower bounds of 110% and 95% of the PD, respectively. Both OARs were assigned a maximum dose of 64 Gy, while the normal tissue was assigned a maximum dose of 66 Gy. A numerical solver, Gurobi, generated solutions for the XMRT and IMRT problems. The dose-volume histograms from IMRT and XMRT solutions were compared. Results: The maximum, minimum, mean, and homogeneity of the dose to the target were comparable between IMRT and XMRT. Though IMRT had improved dose conformity relative to XMRT, XMRT reduced the mean dose to both OARs by more than 1 Gy. For normal tissue, an increase of 5 Gy in mean dose and 27 percent in integral dose was seen for IMRT relative to XMRT. Conclusion: This work demonstrates the benefits of simultaneously modulating photon beam energy and fluence using our XMRT approach in a given phantom geometry. While target coverage was comparable, dose to healthy structures was reduced using XMRT.

07 ISOTOPE AND RADIATION SOURCES↗